Comparative Evaluation of Uniplanar versus Biplanar Valgus Distal Femoral Osteotomy in Genu Varum Deformity: A Prospective Randomized Clinical Trial with 3 years Follow-up

Both uniplanar and biplanar techniques are used for valgus distal femoral osteotomy (DFO) to correct genu varum. While some evidence suggests advantages for the biplanar method, robust comparative studies are lacking. This trial aimed to compare the mid-term clinical and radiographic outcomes of these two techniques. This single-center, randomized, double-blind clinical trial enrolled 80 patients with symptomatic genu varum of femoral origin (Lateral Distal Femoral Angle, LDFA >93°). Patients were randomized to undergo either uniplanar (n=40) or biplanar (n=40) lateral closed-wedge DFO. A single surgical team performed all procedures. Primary outcomes were functional scores (International Knee Documentation Committee, IKDC; Knee injury and Osteoarthritis Outcome Score, KOOS; Knee Society Score, KSS). Secondary outcomes included radiographic alignment (mechanical tibiofemoral angle), range of motion (ROM), complication rates, time to union, and patient satisfaction. Patients were followed prospectively for a minimum of 36 months postoperatively. Baseline demographics and clinical scores were comparable between groups. At final follow-up, both techniques led to significant and comparable improvements in all functional scores (IKDC, KOOS, KSS), varus correction, and ROM (p<0.001 for within-group changes). No statistically significant differences were found between the groups for these primary outcomes (p>0.05). A non-significant trend favored the uniplanar group in early (1-year) functional recovery. The biplanar group demonstrated a non-significantly shorter mean time to radiographic union (6.4±1.1 vs. 7.0±1.3 months, p=0.09). Complication rates were low and similar. Patient satisfaction was significantly higher in the uniplanar group (70.3% "very satisfied" vs. 47.4%, p=0.048) . Both uniplanar and biplanar valgus DFO are highly effective and safe procedures for correcting genu varum, providing sustained clinical and radiographic improvement over a 3-year follow-up. While outcomes are largely equivalent, the uniplanar technique is associated with significantly higher patient satisfaction, whereas the biplanar technique may foster marginally more favorable bony healing. The choice of technique can be individualized based on surgeon expertise and specific patient anatomy. 1